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ADMINISTRATIVE CHANGE FORM PUBLIC OR SEMI-PUBLIC SWIMMING POOL OR SPA

  1. ENVIRONMENTAL SERVICES
    DEPARTMENT

    Steven J. Goode, REHS, M.A., Director
    1001 N. Central Avenue
    Phoenix, AZ 85004 - 1937

  2. MAR-Seal-RGB

  3. WATER AND WASTE MANAGEMENT
    DIVISION

    Kevin S. Chadwick, PE, Division Manager
    1001 N. Central Avenue, Suite 200
    Phoenix, AZ 85004 – 1937 Fax (602) 506-1837

  4. ADMINISTRATIVE CHANGE FORM
    PUBLIC OR SEMI-PUBLIC SWIMMING POOL OR SPA

    Permits are not transferable. This form can be used to change/update the management company or/and billing address. If the owner has changed, please complete the "New Owner Application" online form below.

  5. FACILITY INFORMATION

  6. OWNER’S INFORMATION

  7. *Owner listed should match what is listed for your business license and tax id.

  8. 10. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  9. BILLING/MAILING INFORMATION

  10. Leave This Blank:

  11. This field is not part of the form submission.